1. Regulatory Guidance for Genetic Testing

2. Three Specific Areas Laboratory tests Results of genetic testing – Clinical – Research GenomeWide Association Studies (GWAS)

3. FDA Guidance – Laboratory Tests Non-binding guidance for pharmacogenetic tests and genetic tests for heritable markers issued by – Center for Devices and Radiological Health (CDRH) – Center for Drug Evaluation and Research (CDER) – Center for Biologics Evaluation and Research (CBER)

4. Why Regulate Tests? Unregulated tests may – identify stigmatizing diseases – substantially affect family members – identify disorder for which there is no treatment or action – be difficult or impossible for clinician to interpret – provide misleading information (much controversy over direct-to-consumer genetic testing)

5. Applications to FDA for Pre-market approval and pre-market notification 510(k) Intended use Indications for use (predictive, prognostic, Rx response, drug sensitivity) Methodology Technical interpretation of results (e.g., variant allele) Quality control Clinical validity Clinical interpretation Benefits and risks Claims of effectiveness

6. Oversight of Genetic Testing Centers for Medicare and Medicaid Services (CMS) - Clinical lab oversight – Education requirements for technicians – Quality control of lab processes and proficiency testing FDA – Test kit approval Federal Trade Commission – False and misleading advertising

7. Types of Genetic Tests Newborn Screening Diagnostic Carrier Prenatal diagnosis Pre-implantation screening Predictive and Pre-symptomatic Forensic

8. Predictive and Pre-symptomatic Tests Pharmacogenetic Disease-associated genes or arrays of genes IRB evaluation of the information to be shared and with whom. No requirement for investigator to provide counseling or delve into any downstream areas such as notification of relatives of treating physician. Consent should indicate results strictly related to the research and that results have no impact on diagnosis or clinical care.

9. GenomeWide Association Studies (GWAS) 2008 NIH policy established database of genotypes and phenotypes in order to identify gene associations with diseases or other observable traits. Open access to public – for submission of data Controlled access available to researchers with NIH grants for study of genome-wide analysis of specimens – typically studies looking at 100,000 or more SNP markers that are being analyzed.

10. GWAS – IRB Considerations For submission of information to GWAS – Specimens and data were or will be collected in compliance with 45 CFR 46 (human subjects protection regulations) – All the information to be submitted meets the HIPAA standard for de- identification which requires minimizing risks to study participants by removing the 18 identifiers (HIPAA) and coding using a random, unique code – GWAS studies of these data do not pose any risks (e.g., stigmatization) to particular populations or groups

11. Do any of the consent forms contain statements such as “your data/specimens will not be shared” or “will only be seen by the research team?” Were any of the specimen donors minors? Did the original consent forms limit future use to specific projects or disease states, or to non-commercial research? Were any of the data (e.g., medical record information) collected under a waiver of consent? If any of the above may need re-consent or new consent. GWAS – submitting samples collected in previously IRB-approved studies

12. The Genetic Information Nondiscrimination Act (GINA, 2009) makes it illegal to – make decisions about health insurance coverage or eligibility – make decisions about hiring, promoting, and other terms of employment